Complications and Reoperation Rates of Total Knee Arthroplasty After High Tibial Osteotomy: A Matched Cohort Analysis From a Nationwide Database

Background Arthritic progression after high tibial osteotomy (HTO) can require total knee arthroplasty (TKA). While primary TKA results are reliably favorable, there remains uncertainty regarding outcomes of TKA after HTO. We aimed to compare perioperative complication and revision rates for patients who converted to TKA after HTO (HTO-TKA) vs patients who underwent primary TKA. Methods Retrospective deidentified data were obtained from the PearlDiver Mariner Database from 2010 to 2022. Patients who underwent TKA following HTO were matched in a 1:3 ratio based on age, gender, and Charlson Comorbidity index to patients who underwent primary TKA. The incidence of revision surgery and postoperative complications were compared. Results After matching, 786 patients who underwent converted HTO-TKA were compared to 2356 patients who underwent primary TKA. Patients with TKA after HTO had nearly 4-fold increased incidence of postoperative infection (2.9% vs 0.64%, odds ratio (OR) = 4.7, 95% confidence interval [CI] 2.4-9.1, P < .0001) and wound disruption (6.0% vs 1.7%, OR=3.7, 95% CI 2.4-5.7, P < .0001) compared to primary TKA patients. There was an increased incidence of aseptic loosening (1.8% vs 0.76%, OR=2.4, 95% CI 1.2-4.8, P = .024). History of prior HTO was also associated with a 3-fold increase in incidence of revision TKA within 2 years (6.2% vs 2.3%, OR=2.8, 95% CI 1.9-4.2, P < .0001). Conclusions Patients who undergo HTO before TKA have a higher incidence of perioperative complications and revision surgery compared to primary TKA patients. These data can be useful when counseling patients; however, further research should investigate whether recent advances in surgical techniques and contemporary changes in infection prophylaxis may enhance outcomes of TKA following HTO.